Benzodiazepines — also called benzos — are a class of psychoactive drugs. These drugs are classified as sedative-hypnotics and are commonly prescribed to treat anxiety, insomnia, and other conditions.
While effective in treating such conditions, benzodiazepines are also known for being highly addictive and dangerous to abuse.
The controlled substances alprazolam, clonazepam, diazepam, and lorazepam are all benzodiazepines.
How Do Benzodiazepines Work?
There are many different types of benzodiazepine medications with different formulas and implications. Although most cause the same principal physical effects, absorption time into the bloodstream, dosing standards, and other factors will differ.
To be considered a benzodiazepine, a medication must do one or more of the following:
- Provide relief from anxiety
- Give hypnotic effects
- Relax muscles
- Reduce seizures
- Induce sleep
- Prompt mild memory loss
Benzodiazepines affect an important neurotransmitter in the brain called GABA (gamma-aminobutyric acid). GABA suppresses motor neurons, so neuron activity slows or stops when GABA is present.
Benzodiazepines amplify GABA activity, which results in a slowing of nerve impulses throughout the body. This creates a sedative effect.
Generally, benzodiazepines are classified as either short-acting (cleared from the body relatively quickly) or long-acting (takes much longer to be cleared). How long the benzodiazepine’s effects last will play the largest role in determining which conditions it is used to treat.
Negative Side Effects of Benzodiazepines
Generally, most doctors consider the short-term use of benzodiazepines safe and helpful in treating many disorders.
Some benzodiazepines, for example, are very effective at treating severe alcohol withdrawal. The sedative-like effects of benzodiazepines calm some of the very severe withdrawal symptoms like shaking and extreme anxiety. They can help someone through what is perhaps the most physically challenging aspect of alcohol detox.
In order to prevent abuse, most doctors advise taking benzodiazepines intermittently or for less than one month. Dosing varies by medication.
Short-Term Physical and Psychological Effects
The Short-Term Effects of Benzodiazepine Medications Will Depend on A Number of Factors.
- Which medication is used
- Body mass of user
- Tolerance level of user
- Co-occurring use of other drugs, medications, or alcohol
Most benzodiazepines are prescribed at low or moderate dosage levels. With a low or moderate dose, short-term effects of benzodiazepines may include the following:
- Impaired motor skills
- Fatigue and drowsiness
- Trouble thinking clearly
- Memory loss and impaired memory
- Mental confusion
- Depression and sadness
- Vision impairment
- Trouble speaking (stuttering or slurred words)
- Slow or heavy breathing
- Dry mouth
- Vomiting or diarrhea
- Loss of appetite
At Higher Doses, Benzodiazepines Can Cause All Of The Above Effects as Well as the Following:
- Extreme drowsiness
- Moodiness or mood swings
- Erratic or bizarre behavior
Long-Term Physical And Psychological Effects
Some doctors feel that select patients benefit from long-term use of benzodiazepines for ongoing conditions.
The long-term use of benzodiazepines is problematic for many people because the drug is highly addictive. Effects of long-term benzodiazepine use include the following:
- Impaired thinking
- Poor judgment
- Memory loss and memory problems
- Disorientation and dizziness
- Slurred speech
- Poor muscle coordination
- Muscle weakness
- Cognitive decline
Combining Benzodiazepines with Other Drugs or Alcohol
Combining benzodiazepines with some medications, including certain birth control pills and antidepressants, can cause drug buildup and worsen side effects.
Herbs and medications — including St. John’s wort, certain antibiotics, and some anticonvulsants — can lessen the effect of benzodiazepines.
It can be incredibly dangerous and even fatal to use benzodiazepines with certain substances, including alcohol and opioids. One of the effects of benzodiazepines is to slow the heart rate, and this could prove deadly when combined with the depressant effects of opioids or alcohol. This is just one of the reasons that the U.S. Food and Drug Administration released a warning about co-prescribing opioids and benzodiazepines.
Other Dangers of Benzodiazepines
In addition to the effects and dangers listed above, there are many other possible dangers of benzodiazepine use.
- Accidents and falls: Because benzodiazepines can impair coordination and make the user dizzy and confused, falls and other accidents are a risk, especially on higher doses or after long-term use.
- High-potency illegal benzodiazepines: Made in illegal labs, high-potency illicit benzodiazepines are now available on the street market. They can be as deadly as the notorious opioid fentanyl, as they often contain an incredibly potent analog of clonazepam (clonazolam).
- Older people and benzodiazepines: Prescription use of benzodiazepines among older people has been on the rise, as discussed in a 2018 New York Times article. In addition to being at a higher risk for falls and accidents, older people are at a higher risk of being overprescribed medications. A person may go in for a hip problem and get a prescription for opioids without the doctor knowing about their benzodiazepine prescription.According to the article, benzodiazepine-related deaths among people aged 65 or older in the U.S. rose from 63 in 1999 (with 29 percent involving an opioid) to 431 by 2015 (with more than two-thirds involving an opioid).
What Are Benzodiazepines Prescribed For?
Benzodiazepines are among the most widely prescribed medications in the U.S.
The Following Conditions May Be Treated with Benzodiazepines:
- General anxiety and general anxiety disorder
- Withdrawal from alcohol
- Panic attacks
Benzodiazepines are also commonly prescribed off-label for many conditions, including restless legs syndrome and depression.
Benzodiazepines by the Numbers
Benzodiazepine use has skyrocketed since the late 1990s and continues to grow. According to a 2018 article in the New England Journal of Medicine:
- The number of adults who filled a prescription for benzodiazepines grew 67 percent between 1996 to 2013 (from 8.1 million to 13.5 million).
- Alprazolam, clonazepam, and lorazepam are included in a list of the 10 most prescribed psychotropic medications in the U.S.
- Overdose deaths involving benzodiazepines went from 1,135 in 1999 to 8,791 in 2015.
- Doctors and prescribers wrote 37.6 benzodiazepine prescriptions per 100 population in 2012.
- Between 1991 and 2009, Medicaid expenditures on benzodiazepines increased by almost $40 million dollars, even though the actual price of most benzodiazepines dropped. The increase in usage was more than enough to make up for the difference created by the price change.
Tolerance, Addiction, and Withdrawal
Benzodiazepines offer fast-acting relief of some conditions, like anxiety and withdrawal side effects. This quick-fix effect can become all too tempting for those struggling with these issues. What began as a temporary aid for high-anxiety situations can easily become something needed to get through the day.
Users develop a tolerance to benzodiazepines. This most often occurs in people who have used them for six months or more.
There is also cross-tolerance between benzodiazepines and other depressants like barbiturates and alcohol. Using both substances can be dangerous, especially as the symptoms may feel less impactful, and this could result in taking more.
A doctor might increase the dosage of benzodiazepine or prescribe another benzodiazepine to be taken in addition to the already prescribed one when a patient develops a tolerance for the treatment he or she is on.
If someone has developed a tolerance to a benzodiazepine and is unable to obtain a higher dosage prescription from their doctor, they may take a higher dose of their prescription (two pills instead of one), thus running out of their prescription earlier. This can lead to the user trying to obtain more prescriptions from other doctors or trying to obtain more from the black market.
Benzodiazepine withdrawal is serious. Symptoms may include sweating, depression, insomnia, and agitation.
When someone has become dependent on benzodiazepines, quitting cold turkey can be very dangerous. It may result in muscle cramps, tremors, and even life-threatening seizures.
A professional should always be consulted for benzodiazepine withdrawal. They will generally employ a tapering approach to gradually wean the person off the drug.
Benzodiazepines have long been used to effectively treat a number of conditions. They can be used safely and effectively, especially when taken on a short-term basis or intermittently.
Long-term use can easily develop into a serious problem, and it is very dangerous to mix benzodiazepines with other drugs. Someone who is dependent on benzodiazepines should not attempt to detox cold turkey as withdrawal can be life-threatening. Consult a medical professional before stopping use.